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SAMJ: South African Medical Journal

versión On-line ISSN 2078-5135
versión impresa ISSN 0256-9574

SAMJ, S. Afr. med. j. vol.98 no.4 Cape Town abr. 2008




Pagophagia when ice is not available - drink cold water



Marius Coetzee

Department of Haematology and Cell Biology, University of the Free State and National Health Laboratory Service, Bloemfontein.



To the Editor: Louw et al1 reported in the November issue of SAMJ that pagophagia (pica for ice) was present in 9 out of 16 patients with iron deficiency and some form of pica. In the adult haematology service at Universitas Tertiary Hospital, I have made the anecdotal observation that indigent patients with iron deficiency often have a variant of pagophagia: if they do not have access to freezers and ice, they often drink copious volumes of the coldest water they can obtain. Aristotle and Hippocrates as well as authors from more recent centuries warned against the excessive intake of cold water and ice.2 They probably associated pagophagia with manifestations of iron deficiency.

Nojilana et al.3 estimated that iron deficiency anaemia is responsible for a loss of as much as 0.9 - 1.3% disability-adjusted life-years in South Africa. Only 65.6% of South African households have a refrigerator, according to the All Media and Products Survey (AMPS), commissioned by the South African Advertising Research Foundation in 2004.4 Therefore, only 65.6% of households have ready access to ice. It is possible that excessive consumption of cold water is a common form of pagophagia in South Africa.



1. Louw VJ, Du Preez P, Malan A, Van Deventer L, Van Wyk D, Joubert G. Pica and food craving in adult patients with iron deficiency in Bloemfontein, South Africa. S Afr Med J 2007; 97(11): 1069-1072.         [ Links ]

2. Parry-Jones B. Pagophagia, or compulsive ice consumption: a historical perspective. Psych Med 1992; 22(3): 561-571.         [ Links ]

3. Nojilana B, Norman R, Dhansay MA, Labadarios D, Van Stuijvenberg ME, Bradshaw D, and the South African Comparative Risk Assessment Collaborating Group. Estimating the burden of disease attributable to iron deficiency anaemia in South Africa in 2000. S Afr Med J 2007; 8: 741-746        [ Links ]

4. Statistics South Africa. Report on Census Publicity Research Study February/March 2005. Pretoria: Statistics South Africa, 2005. (accessed 15 January 2008).         [ Links ]

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